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Case Count Map

Epi Curve

Introduction

CDC is collaborating with public health and agriculture officials in many states and the U.S. Department of Agriculture's (USDA) National Poultry Improvement Plan (NPIP) to investigate two outbreaks. The first is an outbreak of human Salmonella Altona infections, and the second is an outbreak of human Salmonella Johannesburg infections. Both of these are rare types of Salmonella, and ill persons in both outbreaks have a similar geographic distribution. Investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak. In PulseNet, the national network of public health and food regulatory agency laboratories coordinated by CDC, DNA is analyzed from bacteria obtained through diagnostic testing of ill people.

These outbreaks can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Illnesses that occurred after June 10, 2011 might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 3 weeks. Please see the Salmonella Outbreak Investigations: Timeline for Reporting Cases for more details.

Salmonella Altona Outbreak Investigation

As of June 27, 2011, a total of 49 individuals infected with the outbreak strain of Salmonella Altona have been reported from 16 states. The number of ill persons identified in each state is as follows: Georgia (1), Indiana (1), Kentucky (5), Maryland (4), Michigan (1), Minnesota (1), New Hampshire (1), New York (2), North Carolina (8), Ohio (9), Pennsylvania (5), Tennessee (3), Virginia (4), Vermont (1), Wisconsin (1), and West Virginia (2).

Among the persons with reported dates available, illnesses began between February 25, 2011 and June 6, 2011. Infected individuals range in age from less than one year old to 86 years old, and 39% of ill persons are 5 years of age or younger. Forty-nine percent of patients are male. Among the 44 patients with available information, 12 (27%) were hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. Thirty three (77%) of 43 ill persons interviewed reported contact with live poultry (chicks, chickens, ducklings, ducks, geese, and turkeys) before becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, 32 identified chicks, ducklings, or both, and 25 (86%) of 29 ill persons with available vendor information reported purchasing chicks and ducklings from multiple locations of a nationwide agriculture feed store, Feed Store Chain A. Ill persons reported purchasing live poultry for either backyard flocks to produce eggs or as pets.

In May and June 2011, laboratory testing yielded Salmonella Altona bacteria from multiple samples: three samples from a chick and its environment collected from an ill person’s household in Ohio, three samples collected from chick and duckling displays at two locations of Feed Store Chain A in North Carolina, and three samples from a chicken and two ducks collected from an ill person’s household in Vermont. Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified a single mail-order hatchery in Ohio as the source of these chicks and ducklings.

Salmonella Johannesburg Outbreak Investigation

As of June 27, 2011, a total of 22 individuals infected with the outbreak strain of Salmonella Johannesburg have been reported from 12 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Georgia (2), Kentucky (2), Maine (1), New York (3), North Carolina (3), Ohio (3), Pennsylvania (1), Tennessee (2), Vermont (2), and West Virginia (1).

Among the persons with reported dates available, illnesses began between March 19, 2011 and May 24, 2011. Infected individuals range in age from less than one year old to 55 years old, and 82 percent of ill persons are 5 years of age or younger. Thirty-six percent of patients are male. Among the 17 patients with available information, 6 (35%) were hospitalized. No deaths have been reported.

In interviews, ill persons answered questions about contact with animals and foods consumed during the week before becoming ill. Fourteen (74%) of 19 ill persons interviewed reported contact with live poultry before becoming ill. Of ill persons who could recall the type of live poultry with which they had contact, 12 identified chicks, ducklings, or both, and 9 (75%) of 12 ill persons with available vendor information reported purchasing chicks and ducklings from multiple locations of the same nationwide agriculture feed store identified in the outbreak of Salmonella Altona infections, Feed Store Chain A.

Findings of multiple traceback investigations of live chicks and ducklings from homes of ill persons have identified the same single mail-order hatchery in Ohio identified in the outbreak of Salmonella Altona infections as the source of these chicks and ducklings.

Clinical Features/Signs and Symptoms

Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts from 4 to 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and those with weakened immune systems are more likely than others to develop severe illness. When severe infection occurs, Salmonella bacteria may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

Advice to Mail-order Hatcheries and Feed Stores Who Sell or Display Live Poultry

Mail-order hatcheries, agricultural feed stores, and others who sell or display chicks, ducklings and other live poultry should provide health-related information to owners and potential purchasers of these birds prior to the point of purchase. This should include information about the risk of acquiring a Salmonella infection from contact with live poultry.

Mail-order hatcheries and agricultural feed stores should implement interventions to prevent human Salmonella infections associated with contact with live poultry.